Lee Jong Hwa, Kwon Seung Cheol, Hwang Ji Hyo, Lee Joon Kyu, Kim Joong Il
Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
Knee Surg Sports Traumatol Arthrosc. 2024 Apr;32(4):896-906. doi: 10.1002/ksa.12120. Epub 2024 Mar 7.
Robotic arm-assisted total knee arthroplasty (RTKA) enables adjustment of implant position to achieve the surgeon's preferred alignment. However, the alignment concept that most effectively enhances patient satisfaction remains unclear. This study compares the clinical outcomes of patients who underwent functionally aligned RTKA (FA-RTKA), mechanically aligned conventional TKA (MA-CTKA) and mechanically aligned RTKA (MA-RTKA).
A prospectively collected database was retrospectively reviewed for patients who underwent primary TKA for knee osteoarthritis. One hundred and forty-seven knees were performed with MA-CTKA, followed by 72 consecutive knees performed with MA-RTKA, and subsequently, 70 consecutive knees performed with FA-RTKA were enrolled. After 1:1 propensity score matching of patient demographics, 70 knees were finally included in each group. The extent of additional soft tissue release during surgery was identified, and the Coronal Plane Alignment of the Knee classification was utilised to categorise the alignment. At the 1-year follow-up, patient-reported outcomes, including the pain Visual Analogue Scale, Knee Society Score, Western Ontario and McMaster Universities Arthritis Index and Forgotten Joint Score-12, were also compared among the groups.
The FA-RTKA group showed significantly less additional soft tissue release than the MA-CTKA and MA-RTKA groups (15.7%, 38.6% and 35.7%, respectively; p = 0.006). Statistically significant differences in functional scores were observed in the postoperative 1-year clinical outcomes in favour of the FA-RTKA group, which had a significantly larger percentage of knees that maintained constitutional alignment and joint line obliquity than those of the other groups.
Functionally aligned TKA showed superior 1-year postoperative patient-reported outcomes compared with those of conventional and robotic arm-assisted mechanically aligned TKA. Therefore, the advantage of RTKA is maximised when the implant positioning is based on functional alignment. The application of RTKA with mechanical alignment has been proven ineffective in improving the clinical outcomes of patients.
Level III.
机器人手臂辅助全膝关节置换术（RTKA）能够调整植入物位置，以实现外科医生偏好的对线。然而，最有效地提高患者满意度的对线概念仍不明确。本研究比较了接受功能对线RTKA（FA-RTKA）、机械对线传统全膝关节置换术（MA-CTKA）和机械对线RTKA（MA-RTKA）患者的临床结果。
对前瞻性收集的数据库进行回顾性分析，纳入因膝关节骨关节炎接受初次全膝关节置换术的患者。147例膝关节接受MA-CTKA，随后连续72例膝关节接受MA-RTKA，随后又纳入连续70例接受FA-RTKA的膝关节。在对患者人口统计学进行1:1倾向评分匹配后，每组最终纳入70例膝关节。确定手术期间额外软组织松解的程度，并使用膝关节冠状面排列分类法对排列进行分类。在1年随访时，还比较了各组患者报告的结果，包括疼痛视觉模拟量表、膝关节协会评分、西安大略和麦克马斯特大学关节炎指数以及遗忘关节评分-12。
FA-RTKA组的额外软组织松解明显少于MA-CTKA组和MA-RTKA组（分别为15.7%、38.6%和35.7%；p = 0.006）。在术后1年的临床结果中，功能评分存在统计学显著差异，有利于FA-RTKA组，该组维持结构对线和关节线倾斜的膝关节百分比明显高于其他组。
与传统和机器人手臂辅助机械对线全膝关节置换术相比，功能对线全膝关节置换术在术后1年患者报告的结果方面表现更优。因此，当植入物定位基于功能对线时，RTKA的优势得以最大化。已证明机械对线的RTKA在改善患者临床结果方面无效。
三级。
